Agrawal, Amit

Kumar, R Kishore

English

Atharva Scientific Publications (E-Jounals)

Vol 4 | Issue 4 | Oct - Dec 2017 Indian J Child Health 462
Editorial
Neonatal screening for congenital hypothyroidism in India
Iodine was characterized as an essential element of thyroid tissue by Baumann in 1895. The efficacy of iodine to prevent goiter was demonstrated by Marine in Northern USA in 
1916–1920. Severe endemic goiter and cretinism had been 
almost entirely eliminated from continental Western Europe and 
Northern America before the 1930’s.
Congenital hypothyroidism (CH) due to the absence of 
thyroid gland in babies was found to be the cause of cretinism 
in most of the infants in early 1930s, and this was considered a 
separate entity from iodine deficiency. Screening for CH started 
in many countries almost 50 years ago, after the screening for 
Phenylketonuria was invented by Dr. Robert Guthrie. Screening 
for CH is the most cost‑effective public health program.
In India, there are several studies demonstrating the incidence 
of CH to be higher than the rest of the world. The current issue 
of Indian Journal of child health has published a study by Prasad 
et al.[1] which is a similar attempt to screen the newborns with CH 
in the state of Jharkhand. However, the limitation of this recent 
study is that it has too small a sample size to talk about incidence 
of CH in India. Furthermore, though many studies are quoted for 
reference by the authors regarding the incidence of CH, lot of 
studies have not done nuclear scans for confirming the absence 
of thyroid and indeed. Indeed, many of these studies either have 
done ultrasound of the neck or treated based on thyroid stimulating 
hormone (TSH) values, which is notable for false negative results. 
This may lead to “over treatment of CH” as many cases either 
have transient hypothyroidism or are due to uptake problem which 
resolves within 1 or 2 years. Kumar et al.[2] showed that the 
screening for CH is overdue in India, with all their babies having 
undergone nuclear medicine scans to confirm the absence of 
thyroid gland and also, they have noticed many of their babies had 
uptake problem too, which were not considered as CH.
It is well‑known fact that newborn babies have a TSH surge in 
the first 36–48 h ‑ so the value of TSH depends on the “timing” of 
the sample and also “accuracy of the sample” in the filter paper. 
Prasad et al. have taken the samples at different times accounting 
for the variable results. Furthermore, the results vary depending 
on the prematurity. Kumar et al. study have shown that the TSH 
values in CH are generally in 100s and if < 80, it is suggestive of 
transient hypothyroidism. The present era is of mass spectrometry 
and next‑generation sequencing methods expanding of the 
newborn screen panel. These might address the technical issues 
such as turnaround time, and decrease the false positive and false 
negative rates [4].
It is high time, India with its vast resources, should start 
the screening program for CH. However, to do that we need to 
have guidelines from academic bodies like Indian Academy of 
Pediatrics and National Neonatology Forum about the timing 
of screening, TSH values for each day till day 7, educate the 
common pediatrician and public about the importance of the 
accuracy of sample to prevent false negative cases and transport 
to the regional lab promptly. We can emulate the guidelines by the 
European Society for Paediatric Endocrinology [3].
R Kishore Kumar1, Amit Agrawal2
From 1Department of Neonatology, Cloudnine Hospital, Bengaluru, 
Karnataka, 2Department of Neonatology, Gandhi Medical College, 
Bhopal, Madhya Pradesh, India
Correspondence to: Dr. R Kishore Kumar, Cloudnine Hospital, 
Bengaluru, Karnataka, India. 
E‑mail: drkishore@cloudninecare.com
REFERENCES
1. Prasad R, Verma A, Verma A. Neonatal screening for hypothyroidism by 
time resolved fluoroimmunoassay in Jharkhand. Indian J Child Health 2017; 
4(4): 542‑544.
2. Kumar K, Ranieri E, Fletcher J. Newborn screening for congenital 
hypothyroidism in India is overdue. J Neonatal Biol 2014;3:129.
3. Gruters A, Delange F, Giovannelli G, Klett M, Rochiccioli P, Torresani T, 
et al. Guidelines for neonatal screening programmes for congenital 
hypothyroidism. Working group on congenital hypothyroidism of the 
European society for paediatric endocrinology. Horm Res 1999;52:49‑52.
4. Almannai M, Marom R, Sutton VR. Newborn screening: A review of history, 
recent advancements, and future perspectives in the era of next generation 
sequencing. Curr Opin Pediatr 2016;28:694‑9.
Funding: None; Conflict of Interest: None Stated.
How to cite this article: Kumar RK, Agrawal A. Neonatal screening for 
congenital hypothyroidism in India. Indian J Child Health. 2017; 4(4):462.


Neonatal screening for congenital hypothyroidism in India

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Neonatal screening for congenital hypothyroidism in India

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